Are you getting the best treatment for your low back pain?

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1 Are you getting the best treatment for your low back pain? Dr.Rahimian Orthopedic surgon Spine fellowship resident

2 Why are we here? To update you on the best evidence for the treatments available To give you a better understanding of low back pain

3 Have you had low back pain? 1. How many of you have ever had back pain? 2. How many of you seek help for your back pain? 3. How many of you have ever had treatment for your back pain?

4 What causes back pain? Most cases, cause is unclear poor posture lack of exercise muscle strains and sprains(70%) Some conditions have specific causes Spondylosis (10%) Herniation(4%) Stenosis (3%)

5 How can I help myself? Regular exercise e.g. swimming, walking, pilates, yoga, going to gym Check posture frequently Lift things correctly Watch your weight Stay at work if possible Keep positive think!

6 What is the outlook for back pain? 75 90% recover within in a few weeks Relapses are common Most lead normal life and able to work Emotional response to back pain important to recovery e.g. worried, depressed,.

7 Red Flags History of cancer Unexplained weight loss Intravenous drug use Prolonged use of corticosteroids Older age Major Trauma Osteoporosis Fever Back pain at rest or at night Bowel or bladder dysfunction

8 What treatments are there for back pain? guideline specific exercise manual therapy Acupuncture Combined psychological and physical therapy Surgery or injections may be considered

9 Treatment Options for Back Pain

10 Exercise & Bed Rest Advice to stay active: There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica. One or two days of bed rest if necessary Light activity, avoiding heavy lifting, bending or twisting. No data on any particular exercises

11 What if my back pain is affecting my work? Work is good for you! financial and social Stay at work or get back as soon as possible. Discuss what can be done to help you when you return e.g. light duties, changing hours

12 Medications Anti-inflammatory medications (NSAID s): Beneficial; no differences; watch side-effects Tylenol: Narcotic Pain Relievers: No more effective than NSAID s Many side effects Muscle Relaxants : Can decrease pain and improve mobility 70% with drowsiness/dizziness

13 Antidepressants Anticonvulsants Corticosteroids Topical analgesics

14 Treatment Strategies for LBP Clinical Presentation Possible Cause of LBP Treatment Strategies Intermittent unilateral leg pain, numbness, weakness radiating to foot Intermittent nerve entrapment with nerve root inflammation Short-acting opioids NSAIDs Topical analgesics Constant burning, stabbing, or deep aching groin or leg pain Permanent nerve damage Opioids Tricyclic antidepressants Anticonvulsants Topical analgesics 14 Moskowitz MH. Curr Pain Headache Rep. 2003;7:

15 Massage Might be beneficial More quality research is needed Different types of massage

16 Acupuncture Very little quality research and data Seems to indicate that acupuncture is not effective for the treatment of back pain

17 Injections Epidural injections: Insufficient and conflicting evidence Facet joint injections: No improvement Local/Trigger point injections: Possibly some benefit

18 Role of Radiology Usually unnecessary and not helpful Plain X-ray: Age>50 years No improvement after 6 weeks Red flag MRI: After 6 weeks if have sciatica Red flag

19 Other Modalities Back Brace/Corset/Lumbar Support Injections Hot/Cold Ultrasound

20 Surgery Discectomy improves pain in short term but not long term (ie. 10 years) Fusion Decompression